Valeur diagnostique de la microscopie confocale fibrée en fluorescence sur le liquide de lavage broncho-alvéolaire pour le diagnostic de pneumopathie à l'amiodarone chez les patiens non-fumeurs

L’amiodarone est responsable d’une toxicité pulmonaire importante qui varie selon les séries de 0,5% à 15%. Aujourd’hui il n’existe aucun examen fiable pour poser le diagnostic de pneumopathie à l’amiodarone (PnpA). La microscopie confocale fibrée en fluorescence (MCFF) a démontré in vivo son intérêt pour le diagnostic de PnpA. La sensibilité est de 100% (IC 95 % : 0,66-1) avec une spécificité de 88% (IC 95 % : 0,47-1) chez les patients non-fumeurs dans l’étude pilote de Salaun et al en 2013. Objectif Déterminer la précision diagnostique de la MCFF ex vivo sur le liquide broncho-alvéolaire (LBA) chez des patients non-fumeurs pour le diagnostic de PnpA aiguë (20μm), fluorescentes avec une intensité supérieure à 100 Lux. Une deuxième analyse portait sur la différence des moyennes de fluorescence et de taille cellulaire entre les groupes A, B et C. Résultats 17 LBA ont été étudiés en MCFF de décembre 2016 à juillet 2019. 11 patients (65%) présentaient un tableau clinique aigu et 6 patients (35%) présentaient un tableau clinique subaigu de PnpA. 4 patients sont classés comme certains (groupe A) de présenter une PnpA par la RCP-PID, 4 patients comme probables (groupe B) et 9 patients comme improbables (groupe C). Dans notre série la spécificité de la MCFF ex vivo est de 33%, pour une sensibilité de 50% (p= 0,64). La taille moyenne des cellules fluorescentes est de 17μm dans les groupes A et B vs 20μm dans le groupe C (p = 0,0008). La fluorescence moyenne est de 39UA pour le groupe A et B vs 49UA dans le groupe C (p = 0,048).Conclusion La MCFF ex vivo ne permet pas de poser avec certitude le diagnostic de PnpA en utilisant les critères de la MCFF in vivo

The effect of stimulus frequency on post- and pre-central short-latency somatosensory evoked potentials (SEPs).

We assessed the influence of the stimulus frequency on short-latency SEPs recorded over the parietal and frontal scalp of 26 subjects to median nerve stimulation and 16 subjects to digital nerve stimulation. When the stimulus frequency is increased from 1.6 Hz to 5.7 Hz, the amplitude of the N13 potential decreases whereas the P14 remains stable. The amplitude of the N20 is not changed significantly whereas the P22, the P27 and the N30 decrease significantly. In 50% of the subjects 2 components can be seen within the frontal negativity that follows the P22: an early 'N24' component, which is not affected by the stimulus rate, and the later N30, which is highly sensitive to the stimulus frequency. The distinct amplitude changes of the N20 and P22 with increasing stimulus frequency is one among other arguments to show that these potentials arise from separate generators.Journal Articleinfo:eu-repo/semantics/publishe

Somatosensory central conduction time after sural and tibial nerve stimulation.

We recorded spinal and cortical somatosensory evoked potentials (SEPs) after sural and tibial nerve stimulation at the ankle in 34 normal subjects. Spinal SEPs were reproducible with sural nerve stimulation in only 65% of normal subjects. The spinal amplitudes were significantly smaller after sural nerve stimulation. Central conduction time (CCT) was significantly shorter when measured from onset instead of peak latencies. There was a significant difference between CCT with tibial nerve and sural nerve stimulation. Our results are consistent with the idea that CCT measures from onset and peak latencies do reflect the travel of the afferent volley in different spinal fiber populations.Journal Articleinfo:eu-repo/semantics/publishe

Dissociation of P13-P14 far-field potentials: clinical and MRI correlation.

P13 and P14 far-field potentials are recorded over the scalp with median nerve stimulation when non-cephalic reference is used to measure somatosensory evoked potentials. The dissociation of these 2 potentials is exceptional. Only 2 cases subsequent to pontine lesions have been described hitherto. We report the case of a 31-year-old woman with a low grade glioma located at the spino-medullary junction who presented a P13-P14 far-field dissociation. This case fully supports the independent nature of the P13 and P14 potential generators.Case ReportsJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Crizotinib-induced osteitis mimicking bone metastasis in a stage IV ALK-rearranged NSCLC patient: a case report

International audienceBACKGROUND:Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib.CASE PRESENTATION:A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset.CONCLUSIONS:This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression

Influence of socioeconomic status on functional recovery after ARDS caused by SARS-CoV-2: a multicentre, observational study

International audienceIntroduction Prognosis of patients with COVID-19 depends on the severity of the pulmonary affection. The most severe cases may progress to acute respiratory distress syndrome (ARDS), which is associated with a risk of long-term repercussions on respiratory function and neuromuscular outcomes. The functional repercussions of severe forms of COVID-19 may have a major impact on quality of life, and impair the ability to return to work or exercise. Social inequalities in healthcare may influence prognosis, with socially vulnerable individuals more likely to develop severe forms of disease. We describe here the protocol for a prospective, multicentre study that aims to investigate the influence of social vulnerability on functional recovery in patients who were hospitalised in intensive care for ARDS caused by COVID-19. This study will also include an embedded qualitative study that aims to describe facilitators and barriers to compliance with rehabilitation, describe patients’ health practices and identify social representations of health, disease and care. Methods and analysis The "Functional Recovery From Acute Respiratory Distress Syndrome (ARDS) Due to COVID-19: Influence of Socio-Economic Status" (RECOVIDS) study is a mixed-methods, observational, multicentre cohort study performed during the routine follow-up of post-intensive care unit (ICU) functional recovery after ARDS. All patients admitted to a participating ICU for PCR-proven SARS-CoV-2 infection and who underwent chest CT scan at the initial phase AND who received respiratory support (mechanical or not) or high-flow nasal oxygen, AND had ARDS diagnosed by the Berlin criteria will be eligible. The primary outcome is the presence of lung sequelae at 6 months after ICU discharge, defined either by alterations on pulmonary function tests, oxygen desaturation during a standardised 6 min walk test or fibrosis-like pulmonary findings on chest CT. Patients will be considered to be socially disadvantaged if they have an "Evaluation de la Précarité et des Inégalités de santé dans les Centres d’Examen de Santé" (EPICES) score ≥30.17 at inclusion. Ethics and dissemination The study protocol and the informed consent form were approved by an independent ethics committee (Comité de Protection des Personnes Sud Méditerranée II) on 10 July 2020 (2020-A02014-35). All patients will provide informed consent before participation. Findings will be published in peer-reviewed journals and presented at national and international congresses

Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study

International audiencePurpose: Survivors after acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) are at high risk of developing respiratory sequelae and functional impairment. The healthcare crisis caused by the pandemic hit socially disadvantaged populations. We aimed to evaluate the influence of socio-economic status on respiratory sequelae after COVID-19 ARDS.Methods: We carried out a prospective multicenter study in 30 French intensive care units (ICUs), where ARDS survivors were pre-enrolled if they fulfilled the Berlin ARDS criteria. For patients receiving high flow oxygen therapy, a flow ≥ 50 l/min and an FiO2 ≥ 50% were required for enrollment. Socio-economic deprivation was defined by an EPICES (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé - Evaluation of Deprivation and Inequalities in Health Examination Centres) score ≥ 30.17 and patients were included if they performed the 6-month evaluation. The primary outcome was respiratory sequelae 6 months after ICU discharge, defined by at least one of the following criteria: forced vital capacity < 80% of theoretical value, diffusing capacity of the lung for carbon monoxide < 80% of theoretical value, oxygen desaturation during a 6-min walk test and fibrotic-like findings on chest computed tomography.Results: Among 401 analyzable patients, 160 (40%) were socio-economically deprived and 241 (60%) non-deprived; 319 (80%) patients had respiratory sequelae 6 months after ICU discharge (81% vs 78%, deprived vs non-deprived, respectively). No significant effect of socio-economic status was identified on lung sequelae (odds ratio (OR), 1.19 [95% confidence interval (CI), 0.72-1.97]), even after adjustment for age, sex, most invasive respiratory support, obesity, most severe P/F ratio (adjusted OR, 1.02 [95% CI 0.57-1.83]).Conclusions: In COVID-19 ARDS survivors, socio-economic status had no significant influence on respiratory sequelae 6 months after ICU discharge

Correction: Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study

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